A new procalcitonin cord-based algorithm in early-onset neonatal infection: for a change of paradigm

Lencot, S.; Cabaret, B.; Sauvage, G.; Laurans, C.; Launay, Élise; Orsonneau, Jean-Luc; Caillon, Jocelyne; Boscher, Cécile; Rozé, Jean Christophe; Guen, C. Gras-Le

doi:10.1007/s10096-014-2065-3

Cited by 22 publications

(14 citation statements)

References 33 publications

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“…Regardless, this situation should not introduce a serious bias because these symptomatic children require systematic antibiotics therapy. Moreover, the diagnostic value of PCT-based algorithm in this study is lower than that already published by Lencot et al when the algorithm was initially derived as the result of a high number of "misclassification" among the probably infected newborns (7). However, the main objective of such a diagnostic approach is not to definitively rule out a neonatal early bacterial infection (all the newborns at risk of infection are under close surveillance in the maternity ward during the first 72 postnatal hours) but rather to improve the stratification of the infectious risk in this specific newborns population exposed to current overdiagnosis and subsequent overtreatment.…”

Section: Weaknesses and Strengthscontrasting

confidence: 80%

“…In a study of 2,151 newborns with suspected EONI (15), the PCT value assessed by umbilical cord blood level preceded this physiological peak, and a cutoff level of 0.6 ng/ml could distinguish infected and healthy newborns. A recent retrospective and monocentric study proposed a new PCT-based algorithm to stratify the EONI risk and suggested a potentially significant reduction in antibiotics prescription rate with the algorithm without missing infection diagnoses (7). In this previous study, the PCT-based algorithm had a 90% (95% CI, 76.9-100) sensibility and a 91.7% (95% CI, 90.6-92.8).…”

Section: Introductionmentioning

confidence: 83%

“…A French study reported antibiotics treatment instituted during the first 48 h of life in 3.9% of 1,217 newborns: 88% were not infected, 11% were colonized, 1% presented probable infection, and none presented certain infection (5). Such therapeutic strategies have consequences and are responsible for perturbations in the newborn microbiota with possible long-term consequences such as autoimmune, allergic, or metabolic pathologies (6,7); resistant bacteria (8); nosocomial infection and necrotizing enterocolitis (9); immune system maturation; mother/newborn separation; and increased cost (6,10,11).…”

Section: Introductionmentioning

confidence: 99%

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Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

et al. 2020

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Context: The incidence of early-onset neonatal infection has greatly decreased, but a new diagnostic approach is needed to avoid overdiagnosis and overtreatment. The aim of this study was to assess the potential impact of an algorithm incorporating umbilical-cord-blood procalcitonin (PCT) level on neonatal antibiotics prescription rate as compared with current practice. Material and methods: We conducted a prospective study in three maternity wards in France. All term and preterm neonates with the usual risk factors for neonatal group B Streptococcus infection were eligible for umbilical-cord-blood PCT testing. We compared the proportion of neonates who were exposed early to antibiotics (before 6 days of life) to that of neonates for whom antibiotics prescription would be indicated according to the PCT-based algorithm. Results: Among the 3,080 neonates included, 1 neonate presented with certain infection and 38 neonates with probable infection. The global antibiotics prescription rate was 4.6% [95% confidence interval (CI), 4.1-5]. With the PCT-based algorithm, the potential decrease in prescription rate would be 1.8% (95% CI, 1.3-2.3), corresponding to a 39% (95% CI, 37.3-40.7) relative reduction in antibiotics exposure (p < 0.05). Conclusion: These results suggest that the umbilical-cord-blood PCT-based algorithm could significantly help the clinicians in their antibiotic prescription decision to decrease neonatal antibiotics exposure as compared with current practice. If validated in a larger interventional randomized study, this approach could help clinicians stratify the risk of early-onset neonatal infection and initiate early antibiotics treatment in newborns at high risk of infection while limiting the deleterious effects of useless prescriptions in non-infected newborns.

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Section: Weaknesses and Strengthscontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

et al. 2020

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“…Numerous reports documented higher PCT levels in umbilical blood of neonates with intrauterine infection. [14][15][16][17] Moreover, PCT concentrations in venous blood of neonates with inborn infection are significantly higher than in uninfected controls even when accounting for the postnatal physiologic increase. Therefore, PCT can be of use in the diagnosis of inborn infections, although it should be remembered that the cutoff point for infection is greater during the first days of life than at later times and so the normal range for adults is not applicable to neonates.…”

Section: Discussionmentioning

confidence: 99%

The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection

Kordek

Torbé

Tousty

et al. 2016

Clin Pediatr (Phila)

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The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 10/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.

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“…To our knowledge, however, no studies to date have confirmed the results of the latter study in neonates with NBI. The results of cytokine assays may be integrated into clinical and biological algorithms, similar to those proposed for early onset neonatal infection ( 34 , 35 ). In these algorithms, PCT concentration in cord blood was found to be an efficient marker that could guide the treatment of newborns suspected of early onset neonatal sepsis ( 34 – 37 ).…”

Section: Discussionmentioning

confidence: 99%

Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study

Dillenseger

Langlet

Iacobelli³

et al. 2018

Front. Pediatr.

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Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.

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A new procalcitonin cord-based algorithm in early-onset neonatal infection: for a change of paradigm

Cited by 22 publications

References 33 publications

Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection

Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study

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